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HomeMy WebLinkAboutMiscellaneous - 31 SETTLERS RIDGE ROAD 4/30/2018 31 SETTLERS RIDGE ROAD / 210/061.0-01040000.0 i ,a �.uixrt. l - zo i 3 �„�i,� p�oz�lCc.rrac� /a� � Gl2cc�D i 71D � � Ph �1ce 317- ;7702 1�"A:�%je Q-ne mifflIP—S.Cobt Ca� North Andover MIMAPra tt5� ��?!lflD�"!'O�✓ �s� 5 Q'( 4 AM I t ph f} •f' f( a £ym t _ R3 I A , Interstates Interstate Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack NORTH Valley Planning Commission(MVPC)using data provided by the Town of r Easements C� North Andover.Additional data provided by the Executive Office of ❑MVPC Boundary ? �.�� r����� Environmental ARaim/MassGIS.The Information depicted on this map is Parcels L for planning purposes only.It may not be adequate for legal boundary F 9 definition or regulatory Interpretation.THE TOWN OF NORTH ANDOVER - MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING {t ♦ THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY ♦ + ; OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION s�C4 1"=71 ft ^�° DEPARnM NPOFPUB Z&FUT Permit No. m BOARDOFFB?EPREVENIIiONRBaIMaA 527aMl2-W pmy b Fees Checked MPPUCARONFOR POW M PERFORM ELECTRICAL WORK ALL WORK To sE PERFORMED IN ACCORDANCE WITH THIS MASSACHUSSrS ELECTRICAL CODE,527 CMB 12:00 i (PLEASE PRINT IN INK OR TYPE ALL WORMATION) Date ff i//;-0$ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perforrn the electrical work described below. Location(Street&Number) -3 / ,j ys F— J d ''� R. G , Owner or Tenant CJ e-.'-7u. h. Owner's Address -3 Sc'hIlcy G,.S ids e Gii-I/T c,,F 13 this permit in conjunction with a budding permit: Yes® No 0 (Check Appropriate Boa) Purpose of Building f� e 5 ,J( 1 c e Utility Authorization No. Existing Service Ampa...L.olts Overhead Under l IM No.of Meters New Service Ampa...L.Volts Overhead Underground C3 No.of Meters Number of Feeders and Ampacity — Location and Nature of Proposed Electrical Work 0---�r1 1 'kt No,of uglaina Outku 17 No.d ut Hot Tube No.of Tnaebnr TOW KVA Na of Lighting Fixtures Swirncdng Pod' Abu" Bel" Oareretps KVA No.of Recepteele Outhtts No.of OB Bueeere No.of Emergency Lighting Botery Units No.of switch Outhus No.d Oce Bomrn No.of Rmwe Na of Air Coad. Tout FIRE ALARM No.of Z xm Tone Na of Dispoeds No.of Na of Dewcdos ud PUMIN Tose KW No.of Dishwuhers Spece AHeeWy KW No. na D Saaabl dng Devisee No.of gaff Cattehad b No.of Dryer Heeling Devtss KW DeleodOWSOnedt DrAm �+d [:3 Mnoisipel � Other Comlecdaa No.of Weser Heelers Kw Na d Na d Slips BaikA6 j No.Hydro Mueye Tube Na of Motors To HP ! OTHER' lnttx=t'Jmts p Aaatan IAA9gamtt+�aflVl9ld>tiatrC�rmlLarta a Ihtneaaaa�tLaNiyhsaraeR�icyrddr�C3r>pi� cribubdahlegivAn YE rp ! Intnes�rrildveiapiodars�nofeomta Yaaywl teaei�dYB4�p�id�� d by i dnddngtte hac $ MUIC4� B�iartaDlrb E*n*dVak dEhm v Wsk s WadcbSmR Its{>ectiortDaRadRoo aw S tedur ftrtftofPa*q- EMMNAME licaseNa 1 i�`� �1° tiomreNo AtTdNa 0WT' R'SIIVSURANMWAIV RI=v=de dxLioaee iheirsario aAtWorblbetanoidtegiiv*ujsm sdbyMae®ftmGnWLa►ts artdd>Btrrry9grdaern diepartiapphbivlvmllslirequfe»elt (Please check one) Owner Agm �✓ ° �-� Telephone No.al nomrUrm or 1 j FEE Date. . . . . .g�. . .... . f NO pTM 1 O 'e.ti0 3= '� TOWN OF NORTH ANDOV wo ° A 41PERMIT FOR GAS INST �LATION • �,SSfCMUSEt 9 This certifies that . .( -�� - has permission for gas installationl�!�. in the buildings of at ` . - -: " f� ��- �_� , North Andover Mass. Fee . .. . . . Lic. No.. f, GAS INSPECTOR . . • , . • • • . • Check#f� a� 6672 I , ( �t MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING i (Print or Type) Mass. Date Permit# Building Location St t i vs' RL c 'Qp4m, Owner's Name Q)Ztkkii,, l�Ecra N� Owner Tel# '?t;' lv b) 2(PS'/ Type of Occupancy New ❑ Renovation ❑ Replacement z Plan Submitted: Yes ❑ No t� FIXTURES � x U) W W w o x x z z o Z ¢ ° ° a a °7 w a ' v� ' ¢F Ln o 0 W Z J H Z W W P+ W E. W U py Z Q W Q � H � rAm Z O Z o ui x a X = o 0 i 3 A a ° °x > ca ° Lu o SUB-BSMT BASEMENT 1sT FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR ff i, 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name 1,e(.1ds'a Q/L-I u�6 Check one: Certificate Address )f..,k/6L ❑ Corporation �Lf/9r�<qPG IYiR- p/fir(, ❑ Part ers hip Business Telephone# ��I �j W _�� 6 3 Firm/Co. Name of Licensed Plumber or Gas Fitter. INSURANCE COVERAGE: I have a curren lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes V No ❑ If you have checked Yes,please indicate the type coverage by checking the appropriate box. A liability insurance policy 2r" Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent 11 I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genera Laws. 15 By Type of License: la� C&-- • -Plumber Signature of Licensed Plumber or Gas Fitter Title •-Gas fitter • -Master License Number City/Town •-Journeyman APPROVED(OFFICE USE ONLY) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street i Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): UM\(G— GG I L54>,\ tj i Address: f,,A City/State/Zip: Md, 6(S 47 Phone#: 5 of 1. 'o 3 Are an employer?Check the appropriate box: Type of project(required): 1. I am a employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. E] Building addition [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[ lumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hireoutside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Al A4 IMU-rd/J-�_ ydt S CD Policy#or Self-ins.Lic:#: A OX )01/ 7 300 12'.007 Expiration Date: / /? � Job Site Address: Nf tftaw. N S411S 7"1 W. . AuQXW /M City/State/Zip: 0/ rr Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. h n O Signature: lir+"'^ Date: / W 0 Phone#: 4 f �I Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." . MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirination of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is.obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington.Street Boston, MA 02111. Tel. # 617-72774900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax 617-727-7741 www.mass.gov/dia 9 x COL1601V VE = ALTS OF N►ASS LICE ' q, ACHUSETTS NSEpMAER'S qNp�! 11, is S q JOURNEYMAN ASFrTTERS sueS THIS r Jcrrrvs opLUIWEEpq . ROBERT GIBSOM 38 TEMPLE ,. ST a , READING <; 2S9 MA 0186-7- $ 31 05/0 2830 1/1 � A r • .w6i6 Date..........-f�.f t NORTH� 3?;•_,, 0 TOWN OF NORTH ANDOVER o '° PERMIT FOR WIRING •D'••TID��``� CHUSf This certifies that . ...... ....04V A'C le ' t-90-L�I !.� ............................................. ................. has permission to perform �j,4St!/I �vT ! F�`Ut 5Lf ......................................... .............. A wiring in the building of..........L J fes/& Gf��� ................... 3 SE 7'j4-`c . ,.....j (, t .......:...... ,North Andover,Mass. Fee... ................ Lic.No.............. .................... ..... .. .. .. . ELECTRICAL INSPECTOR Check # DRM1!'lMF1V1'OFPU M94FUT Penni*Na B04RDOFFLREPRgvzvnUIVRBGULA1XMS27ag12, OmPmy&Fea Checked APPIUCATTON FOR PE W TSO PEUORM ELEC MCA L WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHusm ELECrRICAL CODE,527 CMR 12:00 (PLEASE PRINT 1N INK OR TYPE ALL 1NPORMAMON) Date Town of Nor*Andover To the inspector of Wires: The undersigned applies for a permit to perform the electrical work described below/. Location(Street&Number) 3 / 5 e Y� id Q Owner or Tenant (A) ; 14v- 0- a Owner's Address 3 1 sc h I c i s r- fmmmu� t-e !U o, 13 this permit in conjunction with a building permit: Yea® No [:3 (Check Appropriate Box) Purpose of Building `` e-S ,ice h cc Utility Authorization No. Existing Service -10 0 Amps Volta OVedlead UndergsOund No.of Meters New Service Ampa.../... Volta Overhead Underground C3 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Dy#1"4 a-17 i3 4.5 r,y7t71f Na of Ushdna Oodga Na of Hot TWE No.of TraWi "W" TOW Na of Uahttna Rimm Swbnudna Pod' Above Below KVA KVA No.of Receptacle Outb4 No.of OU Bueoeravow sing id No.of Ernaaeoey Uandna Battery Univ Na of Switeb Ondau No.of an Bowen Na of Randa Na of Air Coed. Tot FIRE ALARMS Na of Zonu Torr Na of Dtapoub No.of Hat Tot TOW Na of Dat W=and Pumps TOW KW Wdmiq Dao No.of Dtehwuhaa Spwe Ara Hestina KW Na of Som Devtea NO.Of Self Coevbwd Na of Dryer Hestina Device KW Local Ods No.of Wats Heaton KW Na of Na of Commdom situ dlab No.Hydro Mueye TW* No.of Mown Tot HP r OTHER' Ir>9ua=Cam PlmauattblElec}ielrabafMaldlieleC�aaall�rYa IhreaaaerLielaT14YhaareaePokzxWftCz#* orbs $le4rivaleB ygy Ihnesrbrri�ledvefdproafdsmedle�m Y$9 NO 0 1<yauharedjadW ,1* 0 d tie bac dmWby WSURAIk� BCI 13 OFR PBIblionDale Rao WadcbStAR lirrper�onDr�Ret}seed �c1Var�dl�torlwaat s Sswdu��afpajw Iknl EI RMNAMB LicQaeNo :� I�tee Stgrrorire LioeneNo Bu*=7hLNa OWIWSMIRANCEWAMRIama ntnttrcl.mm Ak TeLNa *�� arirsUbs�ridegtivalmtas1K0WbyMmmdi>9mCmsWLR" ardthetmys@�zontiapearit�pialwNi� requiems (Pleasek one Age 4�✓ t Telephone No, FEE S Location 3 ,f " tlsf 1 t kocl) No. Date ` r NORT1y TOWN OF NORTH ANDOVER , 3? • • 00 0 w 9 • i Certificate of Occupancy $ CHU tom Building/Frame/Frame Permit Fee $ L cMuse 9 0 07 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18779 Building Inspector TOWN OF NORTH ANDOVER. BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING .. WOW BUILDING PERMIT NUMBER DATE ISSUED. OT SIGNATURE: _ Building Commissionerfl r of BuildingsDate • �' Z SECTION 1-SITE INFORMATION I 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: - 3 Rid e 210 / � � - /i f O, A ii U�' ©/ �p� Map Number Parcel Nu ber 1.3 Zoning Information: ' t 6 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R 'red Provide Required Provided Required Provided v 1.7 water Supply M.G.L.C.40. 34) 1.5. Flood Zone Infomntion: 1.9 Sewerage Disposal system: Public Private ❑ Zone Outside Flood Zone Municipal A On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M- 2.1 2.1 Owner of Record is CA e h 5d A14,11j, �1 5,e#f e( Name(Print) Address for Service: 0 g� 49 8?- 071CF-1 IL Signature Telephone a 2.2 Owner of Record: L4 Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.7 Licensed Construction Supervisor: Not Applicable Jr Licensed Construction Supervisor: O License Number M Address D Expiration Date ic Signature Telephone �. 3.2 Registered Home Improvement Contractor Not Applicable O v Company Name rn Registration Number r Address r 0 Expiration Date Z Signature Telephone G) Q. SECTION 4-WORKERS COMPENSATION(M.G.L, C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No......7s1 SECTION 5 Description of Proposed Work check all applicable) New Constion ❑ Fxisting Building A, Repair(s) Alterations(- r '� Addition ❑ t Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description Prwosemd Work: b a Ft'n t,5 '00,-y f o A o 40= e S eA,��. �rd�-!.�a�e /6 x�2� 1/0 OA- 9 f�c�SS dOy3, 1 ea 1" 1' 114 ��(1 PPI sari_ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be -001CIAL USE' ONLY Completed by permit applicant I. Building /� (a) Building Permit Fee �! v Multiplier 2 Electrical 6 (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 4L 0 �7 5 Fire Protection `�7 s` 6 Total 1+2+3+4+5 too Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN 3 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT e . * s I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief r Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1sr2ND 3RD SPAN DlIvIENSIONS OF SILLS DIMENSIONS OF POSTS DR ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: /4 A�oy 02 P o 5' JOB LOCATION: J I �� �eVS ��� e A 109 - Number Street Address Map/Lot HOMEOWNER IJi !i 1°(Xm A7, fiZrta hef 6 P-a6V 9_)8-3/V' ?&? Name Home Phone /Work Phone PRESENT MAILING ADDRESS e /e I� ecl% led `4 1-1Jouf_!�; m P1 O /8.,Y,5- City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE lam✓ ��y.�, G' "I APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Foran Homeowners Exemption t .,; t Y II TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT RRENOVATE; OR DEMOLISH A ONE OR TWO FAMILY DWELLING EP 4 1 8 BUILDING PERMIT NUMBER: DATE ISSUED: _ X SIGNATURE: �. f • BuildingCommissioner/I r of Btrildin Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Ah Map Number Parcel Nu bet 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr Use Lot Area Fronta ft 1.6 BUILDING SETBACKS ft Rear Yard Front Yard Side Yard ReqWred I Provide Regitired I Provided ReqWred Provided 13 Fiood Zone Infomntion: 1.8 Sewerage Disposal System: 1.7 Waw Supply KG.L.C.40.§34) ZoneOutside Flood Zone Municipal A On Site Disposal System ❑ PublictA Private 11No m SECTION 2-PROPERTY OWNERSIi1P/AUTHORIZED AGENT Historic District: Yes— 2.1 Owner of Record iam Name(Print) Address for Service: tjJ-4,, L Signature Telephone 2.2 Owner of Record: ^^ V Name Print Address for Service: Z Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor. — O License Number Address Expiration Date aa. Signature Telephone r p� 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number e.. Address Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building rmit. Signed affidavit Attached Yes.......❑ No......Cts SECTION 5 Description-0 Proposed Work check all a licable New Constru tion ❑ Existing Building A Re Pte(s) ❑ Alterations(s "t Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description$PrgposW Work: A t t SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Complete b, rmit a licant 1. Building (a) Building Permit Fee 2 Electrical V Multiplier o — (b) Estimated Total Cost of 3 PI ing Construction Building Permit fee(a)Y (b) 4 Mechanical HVAC 5 Fire Protection / 00 6Total Di -#f e6 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN * OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT •�' I ' ��T as Owner/Authorized Agent of subject property r Hereby authorize e My behalf,in all matters relative to work authorized b this building to act on Y g permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, property as Owner/Authorized Agent of subject hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A cnt Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Isr 2 3 SPAN DIMF,NSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL,OF CHIIVINEY IS BUU DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of over No. 3 ?SMO O• = �A r dover, Mass., 11401k 05 COCHICMEWICK A. A0RA7ED p' �CC7 S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... .1.41. ..�.hi . ... .... 't.. ................................... ' """""""""" ..r" Foundation 31.....5.x... ,crs.... �..... �... Rough has permission to erecf��.�. ..! buildings on ................ .... �. 1 t0 be Occupied as....... ..�. 14�...... Ir .. � � . .. .. . ).............................. Chimney Ch' e provided that the pars n accepting this'permit sha I lin every respect conform to a terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. of 6 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTT STARTS ELECTRICAL INSPECTOR Rough :. . Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. P SEE REVERSE SIDE Smoke Det. p- n Die Commonwealth of Massachusetts ' `" °" 01''Y )//) t'••rrlt Sn. `.J�� l Department of Public Scifcty 0"".I-c' S Fee CTeeked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 lteC blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Mamachusetu Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL IMFORMATION) Date 3- RF City or Town of Ay ga✓E.e To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) .3/ SE T-7-L,5•e.5 W _? Os.-ner or Tenant ,L/SA 'D6m4,e Q/t/ Owner's Address SAME 978,) G,' 7 -36 02 Is this permit in conjunction with a building permit: Yes ❑ No 21 (Check Appropriate Box) Purpose of Building Utility Authorization 110. Existing Service Amps / Volts Overhead ❑ Undgrdl 1 Nn. of Meters _ New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of Alarm System No, of Lighting Outlets No. of Hot Tubs No. of Transformers TKVA1 No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners , Batter Emergency Lighting No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges Total No. of Detection and g No. of Air Cond, tons Initiating Devices No. of Disposals No. of Heat s Total Total No. of Sounding Devices Tons KW g No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal 1:1 ❑Other Connection No. of Water Heaters KW No, of No. o iw Voltag Signs Ballasts No. Hydro Massage Tubs No. of Motors Total HP OTHER: c') s Ko r-E DE'T90_7Z Ie INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO ❑ I have submitted valid proof of same to this office. YES❑ NO p If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S y// 00 Expiration Date Mork to Start V-G- 98 Inspection Date Requested: Rough Final J/- Signed under the penalties of perjury: FIRM NAME A.D.T. SECURITY -SYSTEMS NORTHEAST INC. LIC. No. 1231C Licensee DONALD A BROOKS Signata NO, 1231C Address 60 William Street, Wellesley, 8 s. el*No. 413-732-4400 Alt. Tel. No.617-431-5831 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) 00 Telephone No. PERMIT FEE S 3s (Signature of Owner or Agent Not I J 21 Date...`al.L11717.r. NOR7M °ft"`° '•�"° TOWN OF NORTH ANDOVER F Siam, p PERMIT FOR WIRING y� °• •'' h a s$ACMUSEt EE This certifies that ..A D ..T.......5.�' has permission to perform .. .................. l. ./.�..�:......................... wiring in the building of.........00.n^IPL..C. k..t............................................. at.......3.1....SH..t h 5....h..�A., ............ .North Andover,Mass..'. 0 Fee...-3 .� .('X)... Lic.No./�..3.1K............................................................... ELECTRICAL INSPECTOR " C V ti ������6� y = WHITE: Applicant CANARY: Building Dept. PINK:Treasurer v � -- office uae only CI U4P L1ITIIIITQIIIIIPIII IIf -MaSaL1I5Pi Permit No. . Epartzinn of Ouhl'tt tq Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 C.111 12:00 3M (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date - D-7 -�7 Mx or Town of_ NORTH AunvzR To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) L16—k ��Z Syl._c r (,-& cc c I Owner or Tenant __ ( L--e_—e64 64 Owner's Address / L� k(-L440,ti Is this permit in ccnlunction with a building permit: Yes fr" (Check Appropnata Box) Purccse of Suildina _1LwL.-�c-� , Cr Utility Aumonzation No. 0LL O Existing Service Amos —1 Vcits Overneaa _ Unagrno [ No. of Meters New Service -Zf--'O Amps 11Q/ _L'4C�_\/alts Cverneac _ Uncg.no No. of Meters Numoer of Feecers ano Amcacay Lccaticn aria Nature of Prccosec Elec:r:cal 1.11crx Tatar No. or L:gn;,ng Outlets �� I No. o! Hct .:=s i No. cf :ranstormers KVA No. of Lignnng F;xtures t Swimming ?col Above- ;n- Z grna. _ grnc. _ I Ganerators KVA No. of Emergency Lighting No. it Rececrac:e Outlets YO No. of CilBurners I 3arery Units / No. of Sw,tc i Outlets No. cr Gas =urners I FIRE ALARMS No. of Zones is Intt No. at Ranges I No. c! Air Ccr.c. Toro, No. of CeCotaha cons Cavic Devices Na. of Oisoosats ' I Noor Heat Total Total ?u-zs Tons K`V No. ct Sounaing Devices No. of -m n n ANo. of Dishwashers I ScacetArea Healing Oetec::anrSounctng Oevtces No. of Dryers HeatingW Muntc:ow Devices KLecat Cannec'ton _Other No. -_t NO. at Low Voltage No. of 'Nater Heaters KN Signs 9aiiasa Wiring No. !-ivcro Ntassage Tubs ' I No. of Molars Total HP OTHER: INSURANCE CCVERAGE: Pursuant :o the reeutrements ct %tassacnusecs ;enerat _aws I have a current Liaotiity Insurance Pouc/ tnc!ucing Com^:et ceratiens :.;,verage or :ts suos:anuat eeuivatent. YES 1 nave suomtrtso vatic goof of same to the Office. YES '`y NO = it you rave cnecxea YES. tease inatcate mo type at coverage cy checxtng the aopro9uato oox. INSURANCE _ SONO = OTHER = tP!ease Scec:lyj (Exotrauon Oatet Esttmatea Value of E!ectncat 'Nora 3 ` UO(D C.1/t Worx :o Start Inscecaon Data Racues.ac: Rougn C_A'Lk-- Fnat Signea uncer •he Penalties of perjury! FIRM NAME �NL14Z� CSL^t_ � SAN J t� Llc. VO. 4d Licensee gnature UC. NO. -u � Sus. :et. No. 66-, o1 V 7--Z`7g-f Acaress � U",) C tI i c 0�1Alt. Tel. "Jo. OWNER'S INSURANCE WAIVER: I am aware that the !:censee aoes not nave the insurance coverage or its suamanttal eautvalent as re- auirea oy Massacnusetts General Laws. ana ;hat my signature an ^.:s 7ermtt aDpttcatton waives this reQlNrement. Owner Agent (P!ease cnecx anal yY /�/�7 ) etecnone No. nAMIT FEE 5 (Signature at Owner or Agentt it-4565 Date 1105 EE ...........�...� ........... A f HpRTh 1 o TOWN OF NORTH ANDOVER '° PERMIT FOR WIRING ,SSACMUS� This certifies that 41............................................................... 1 has permission to perform- <'`i--'�h :.......................:�.................. .............. wiring in the buildin of . .... .rr... .. .... . -.rX.�l.... ................. .North Andover,Mass. j ? ELECTRICAL INSPECTOR WRITE: Applicant CANARY: Building Dept. PINK:Treasurer PERJIIT 3O. APPLICATION FOR PERMIT TO BUILD- NOETH ANDOVER, MASS. PAGE 1 MAP 4-40. ( LOT NO. c RECORD OF OWNERSHIP DATEBOOK ;PAGE ZONE SUB DIV. LOT NO. j Ler �1�v1-3/e I I t.�.51"`f�' b Z ► 3 / LOCATION c �! Zq.Q C (�,/�� PURPOSE 6F BUILDING I S 'F:, A , 1/ OWNER'S NAME) Al.a Re J) 1 4� )b=fyl NO. OF STORIES /� SIZE OWNER'S ADDRESS ` •`c l C �Y ll l l �• BASEMENT OR SLAB iIAt-S t&� Jr CJ ARCHITECT'S NAME 1 A n b- LA'Ik* �v- C-0 SIZE SIZE OF FLOOR TIMBERS IST 2.A Ip 2ND �7„ �J1 3RD A 11J� BUILDER'S NAME TA L-rl 6 i 1 \;j1,�� Cof>P. SPAN K A CSC C. DISTANCE TO NEAREST BUILDING 4 t1r DIMENSIONS OF SILLS ( \ ^� x L p'e`r DISTANCE FROM STREET Z n j TJ '� POSTS�4i'�J 1�G2- vT 1 L n L_�_�_ DISTANCE FROM LOT LINES -SIDES 20/-v REAR //1/�!,r. '� GIRDERS (LlZK V`h /T AREA OF LOT 71Z_ L r} FRONTAGE KFI�� HEIGHT OF FOUNDATION �G" / 1 THICKNESS 'hal IS BUILDING NEW y�! P G� SIZE OF FOOTING O /1 O X b V IS BUILDING ADDITION Nd MATERIAL OF CHIMNEY p Q \ClA l&Lc2 cK IS BUILDING ALTERATION NV IS BUILDING ON SOLID OR FILLED LAND SQL WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER i1� BOARD OF APPEALS ACTION. IF ANY /i lY IS BUILDING CONNECTED TO TOWN SEWER <y�&b'5 !�[ IS BUILDING CONNECTED TO NATURAL GAS LINE }/t�y INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST 1 2 Q Oda SEE BOTH SIDES A EST. BLDG. COST e(BS'J�+.�' �Yg t Zt�d1 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. G S, PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM �O N / SEPTIC PERMIT NO. i A �O ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY �'l ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSP TOR 7 DATE FILED b/Z L `T— BUILDING INSP[CTOR NAT OF NER OR O IZED AGENT FEE OWNER TEL.# PERMIT GRANTED CONTR.TEL.# V 19pow 0-57-C 5-111,( 7 CONTR.LIC.# Ism H.I.C.# 0�t,,-7 cl `o � � e r BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIESTHIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES —_ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 (3 CONCRETE SL K. PINE _ BRICK OR STONE HARDW LASTER _— PIERS PLASTER ✓ _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL / FIN. BM'T' AREA _ '/. 1/2 3/. FIN. ATTIC AREA NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS V, B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW'D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC SIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.( _ GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT H SHED WATER CLOSET _ ASPHALT SHINGLES ✓ LAVATORY _ WOOD SHINGES KITCHEN SINK ✓ SLATE NO PLUMBING _ TAR 3 GRAVEL STALL SHOWER ✓ ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING I i l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBE�_BMS.-''& COLS. STEAM STEEL BMS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G a UNIT HEATERS " t 7 NO. OF ROOMS OAS IL B'M'T I ELECTRIC 1st S 13rd I NO HEATING own of North Andover Planning Board This form represents the schedule for allowing the following lots to be considered as eligible for building permits under the Town of North Andover Growth Management by-law Section 8.7 of the Zoning by-law. Pursuant to 8.7 .5 this Development Schedule must be filed in the Registry of Deeds and be referenced on the deed of each of the lots below and be filed with the Planning Board prior to the issuance of any building permit or permit for construction. Name and Address of Applicant for Lots: Name of Development. )1 Thomas D. Zahoruiko Settlers Ridge (off Bradford Street) U 185 Hickory.Hill Road North Andover, MA 01845 Map and Parcel of Original Lot: ,ANP Col , P Pc6L S Date of Application for Lots Division: January 24, 1997 Q` Lots Covered by this Schedule: Lots 1 - 11 Settlers Ridge Road Pi,�12 / 300 7 a The Planning Board by their signature below, or a signature of a duly authorized representative, 4� do hereby establish for the above named development the following Development Schedule for the purpose of Section 8.7 of the Growth management By-Law. The applicant, their assignees, successors and or subsequent property owners shall conform to the following schedule that limits the eligibility of the following lots for building permits. This form must be filed in the Registry of Deeds by the property owner or representative and be referenced on each deed for each of the following lots. Such deed reference for the deed of each lot shall at a minimum reference the book and page in which this Development Schedule is filed and contain the language : ° This lot is subject to a Development Schedule pursuant to the Town of North Andover Zoning By-Law all owners, representatives, and future purchasers should avail themselves of said restriction by reviewing the approved Development Schedule as filed in Book insert here and Page insert here. The fact that a lot is eligible for a building permit is subject to the limitation of the number of building permits per year pursuant to section 8.7.2.d of the Zoning By-Law." = -3` T The Planning Board hereby schedule the lot(s) for the above development as follows: Year Eligible Number of Building Office Use Building Office Use Lots Eligible Date Lot Eligibility Notes Completely Utilized 1997 6 1998 5 Signature of Planning Board member or Authorized Representative L(q�- per Ow Date Ta a tura of P gve ro w °�ortho ' ed Representative P P BY- /A� omas a o, resp D to � I ►ORTown T � e of i3over No- 3 * z. .` AKE dover, Mass., G 19 g, ' L '► w COCNICMEWICK ~�'�• K . E D�PA�y .(y S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT I�CAk t ..................... .................... ....�� � .c.,W.....b-.01)................................................. Foundation has permission to erect..................I.................... buildings on .......�3/.........�, �/�$........ �.Q.G Rough tobe occupied as.........................................S.i/...'Q. .. ............ .. / i/�'��../................................................... Chimney .. provided that the person accepting this permit shall in every respect conform to the rt.-of.the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough ................................. .. ...... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — -Do Not Remove Fi ugh E Fnal No Lathing or Dry Wall To Be Done _ Until Inspected and Approved by the Building Inspector. DEPARTMENT Burner Street No. Smoke Det. FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************)Applicant fills out this section***************** APPLICANT: alt A Dew/ Phone 6?7_Z63._ LOCATION: Assessor's Map Number 61 Parcel S Subdivision � R, Lot(s) / Street C_ c-S R� St. Number st ************************Official Use Only************************ RECOMMENDNSt F TO AGENTS: ' Date Approved Conservation Administrator Date Rejected Comments Date Approved q1Y, wn nner Date Rejected Comments Date Approved Food I p�r-Health Date Rejected Date Approved e'ptic Inspector-Health Date Rejected Commentss�- Public Works - sewer/water connectionsJ2-14 - driveway permit � � J Fire Department Received by Building Inspector Date L.4T 2 `� ►TE PLAN Z7LASE D�rTE /z a/9 7 Tara Leigh Development Corp. 185 Hickory Hill Rd. S � ' 6+06N. Andover, MA 01845 /� •�' 00 C) •1 / CROP 1 IV Ppop KA rER 00 \,; - COT 2 - tri c x i Iy N -DIP --= `�qy - LOT2, FnN r PIT 99 -- z,o 9g - X24 " P _ S = 0.005 , - - sp/(L 4'"-Y 24" FL ARED END " i CERTIFICATE OF USE & OCCUPANCY r Town of North Andover Building Permit Number 312 Date September 19, 1997 I THIS CERTIFIES THAT THE BUILDING LOCATED ON Tara Leight Dev MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE j WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND iI SUCH OTHER REGULATIONS AS MAY APPLY. 1 w 1 HORT,{ Tara Leight Dev CERTIFICATE ISSUED TO ADDRESS __i m Hickory Hill a ; No A dover MA 01845 4$4 "Ube Building Inspector I OR Town of Andover * _ 7Z7 dove r, Mass., 19 9/ -1 U C OMICME BOARD OF HEALTH Food/Kitchen PERMIT T D Septic Sys!�_m BUILDING INSPECTOR THIS CERTIFIES THAT....... ..................................I....... ................. .............:........:t........ ................................................ Foundation has permission to erect......................................... buildings on ....... .............................. ...........................I................ ..... . ug to be occupied as......................... '*........................................................................ .......:..................................................... C provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBINGINPE(:70R VIOLATION of the Zoning or Building Regulations Voids this Permit. u V/ p ""e PERMIT EXPIRES IN 6 MONTHS in �, - ELECTRICAL �NSPEC UNLESS CONSTRUCTION STARTS o�u ................................... Service Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — -Do Not Remove Rough Y2 No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT 4 - Street NO. (4 A V- 3 Smoke De • �,, ' NORTH ANDOVER, Mast. Osie . .ip�2 a��' BundlnQ , Permit Location . lei W',cv,� — C�T" Owner' Name �ee e New M,- Renovation p Replacement Q Plant Submitted: yes p . No.p FIXTURES at « w s w ! M J N O i i H • p D' N ! M N �j rr Q Jan ON t �' Vbag ! el �a IL ! ! d tAt�IM�NT IST FLOOR I f y SHO FLOOR 3 . .. >tllo t*Loort 4THFLOORsoon w tTM 'LOOA dam IL eTN FLOOR tTN FLOOR JRaw - tTNFLOOH- +F R n Check one: Codklate II Installlnp Company Name )eG>'v G�(o �'/5��,�j�y)p p Corp. .. Address o? >Jt/G(:j p Partnership El FIrm/Co. Business Telephone Name of Ucensed Plumber INSURANCE COVERAGE: L;n - I have a current ilabl Insurance cy ec xon llY poll or Its substantial equlvalent. yes CCS No p N you have checked jW. please Indicate the type coverage by checking the appropriate box. A Ilabl.Ay Insurance pottcy Other type d IndemnRy O Bond El OWNER'S INSURANCE WAIVER: I sm aware that the iiceniet does not have the Insura Chapter 112 nce�coveriQs required by d the Masa. General lows. and that my signature on this permit application,w&W&&.thia ._ eased.-- Check one: .. ..__.__. . .:_._. a care o er.of N.s m Owner Q hereby certify that aN of the details and Inlormallon I haus aubrt�iited for entered)Mn shore lnowbd s and that all binq work and InrhJtattona aPD�ilon sit truaand acimats W"..OAsl,.0my. p p performed under the pertM Issued for tw cep Lion wIl be.In peAinenf provlslons of the Massachusetts State PkenWnp Code and QupiM 142 awmaj L "Plana with aN TRIOnor ur� GtylToryn License Number M TOED(OFFICE USE ONLY) Type of PMmbina License: Master e� • .Jownsymart Q j t . . . i Date. . % . ' _ 341. TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING &S US This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . plumbing in the buildings of .,. �.!? �.-�. . . . . . . . . . . . . . . North Andover, Mass. Fee.9.).)..7 . .Lic. No. . . . . . . . . . . PLUMBING INR 08/08/97 18:20 22 WHITE: Applicant CANARY: Xi ding`%. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTIN, G � (Print or Type) f NORTH ANDOVER Mass. Date F. 4uilding Location J �� Permit # op�'OJ� Owners Name V. • New ✓Renovation D Replacement Plans Submitted D FIXTUP-S W N to v x to a .o y s F za W f— a a z a o z w Z m to t- w w ° ° Q a t- x W d H y 4 totr W z V x m W Rc a 0 a h X cWs lW- i �, r z lx. W w a a > k IW- v .s I�� . w z a W <rz f- y- ° ad z o z a o N x ,u > a W = z Q t` a a z v c� z a -:r a o < col � y Q o°. t'`t- o SUEk BS MT. t BASEMEMT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTK FLOOR 8TH FLOOR (Print or Type) Check one: Certificate Installing Company Name ePe y b'- Corp. Address Aa, c�/��,d � : �' Partner. i(/t�l_.eJ 21 4-4'k D_��S—� � Firm/Co. Business Telephone/--6,63 -3,2.2 79a S Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Fli-;; �Other type of indemnity [--j Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 0 Agent El I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit iueed for this application will-be in compliance with ail pctdnent provisions of the Massachusetts Slate Cas Code and Qmaptes 142 of the Genual Laws, , By YPE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town: sten 22�—Flumbe Gasfitter Journeyman j/-s-'Ver APPROVED (OFFICE USE ONLY) License Number r• � / � 6 J J Date.. j.:�..I J.... .... A ,AORTM TOWN OF NORTH ANDOVER g pF •�ao ,a1h0 + PERMIT FOR GAS INSTALLATION F D a • a r a N nJ �9SSACHUSEt ..a Q^i This certifies that . . g/i . . . . . . . . . . . . . . . . .S has permission for gas installation . . .A.l e. ! . .E�� �• in the buildings of .!r�`I . . . . . . . . . . . . . . . . . . . . . . . . . . at . ./. . S.�. .'`�'r'•J . . .��. .�.f . . . . .. North Andover, Mass. Fee. .7f. .:. . Lic. No././ . . . . . . . . ASINSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Date...... NORTH ° '•�"a TOWN OF NORTH ANDOVER p PERMIT FOR WIRING * 41i ,SSACMUS� i i i j �. �_ � This certifies that ...........:................................................................................. "has permission to perform ....r' .�� ....'.................................................... wiring in the building of.... .... Q.--......................................... I tat...,?.�..... ....:`?`.......... .... ............�..... . "2,Z....... ,North Andover,Mass. Fee�.<............... Lic.No�`.Z..,/.� r......... .................. t ELECTRICAL INSPECTOR I Check # f Lr 4 � -- TBE COMMONWF LTHOFMASSACHUSETTS Office Use only DEPARTMF.7 TOFPUBMS4MY Permit No. O ?/ BOARD OFFIREPREVEVHONREGUT4770NS527CMR12VO �,/c ✓. • Occupancy&Fees Checked APPLICA71ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date�� Z J 0 " Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) ,`S Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes 0 No (Check Appropriate Box) Purpose of Building 465—'-Z)E,,i Utility Authorization No. _ Existing Service Amps / Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work b)l E l ?--TDAJ AIC- No. GNo.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No_of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No_of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices NS of Dryers Heating Devices KW LocalMunicipal Other Fi Connections a No.of Water Heaters KW No.of No.of Si s Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER- hmuartoeCover�FUtstkrtbitterequirartatsofMassadxtsettsGateralLaws �, IbareaomtxtivbiTtykEwdrePobcyirridMCorr>piee CbwrdWorissubstFtMequivabt YES NO IbaNcab nmcdvaidpmdofsEtmiD rOffice.YES F)mbmdrdodYES,p�mdc&drvA eofcovw,�rby dAangtheWPCyd1ACbo 1�! INSURANCE BOND [::] MHRR F-1 (PleaseSpeody) ` u Eqi�6onl)& EMm*dVAwolFhctucalW«k$ WorktoSta<t Z- kq)ecfionD.*Re4test0d Rough 1�•w�/ L�—�-- rgld suiod underTrPer>rtlhes of perjtuy FIRMNAME >tic t/ LioatseNo. rI � Lice tC t.� NLA��o va-c�r� Sigri�teLiar No 2- $ BussinmTel.No. L02,, 2- cog Arlcfircc �( �^� wC>0 > ��D�✓�c -q �� AITUNo. --77 u 3s-7. —Ob"(-,� OWNER'S IN WAIVER IamawaredridrLxmsedoesnothavetheffnmoeooverageoritsatsUttialequivale tasregtmadbyMassadnsettsGardLaws arxlthatmysigoahaeonthispmntapphcabonvammEsth wgm'eanatt _ (Please check one) Owner Agent . yf Telephone No. PERMIT FEE$ Td rgna ure ot Uwner or Agent Z The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Ir' Boston, Mass. 02119 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address Cibc Phone# Insurance.Co. Policy# Company name: Address City: Phone# Insurance Co. Policy# Faikire to secure coverage as required.under section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 an wor one years'imprisonment_as_rrelLas_civil_penalties-olhelmn-fa-STOP VI WDRD R d_aline-fo71t M)-atlay.gainst.m-- I understand that a copy of this statement may be forwarded to the Office of Investigations of the DW for overage verification. do hereby cer6irry under the pains and penalties of perjury that the irrformatiorr provided above is bue and correct_ Signature Date Print name Pbone.# Official use only do not write in this area to be completed by city or town official .� city or Town Permitilicensing p t Building Dept pCheck I immediate response is required .D Licensing Board F-1 Selectman's Office Contact person: Phone#- E] Health Department Ei Other